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Health issues and nutrition in the elderly

Exploratory dietary patterns and cognitive function in the “Seguimiento Universidad de Navarra” (SUN) Prospective Cohort



Dementia is projected to affect 135 million by 2050. Diet is a pertinent target for primary prevention, but firm recommendations for dementia prevention are not available yet. Our aim was to address the association between exploratory (empirically derived) dietary patterns (DP) and changes in the Spanish Telephone Interview for Cognitive Status (STICS-m, maximum score = 41 points) over 6 years.


Information on diet was collected with a validated 136-item food-frequency questionnaire from 803 participants in the Mediterranean cohort “Seguimiento Universidad de Navarra.” We used principal component analysis to derive exploratory DP. The derived DP were associated with change in STICS-m scores over 6 years, through adjusted multiple linear regression models.


Two main DP were identified. The first DP resembled a Western dietary pattern (WDP)—high in sugar, fat, processed foods, and red meat—and the second DP resembled a Mediterranean dietary pattern (MDP)—high in vegetables, fruits, nuts, fish, and olive oil. Adherence to the WDP (tertile 3 vs tertile 1) was significantly associated with negative STICS-m changes after 6 years (between-tertile difference in changes: –0.80 points; 95% confidence interval [CI] –1.51, –0.08, p value = 0.03). Meanwhile, the MDP showed a positive +0.71 point (95% CI 0.15, 1.26, p value = 0.01) between-tertile difference in changes in the STICS-m score.


A healthy, prudent, MDP was associated with less decline in cognitive function and, thus, could help to lower dementia incidence. Western-type diets were associated with a greater decline in cognitive performance and could increase dementia incidence.

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Fig. 1: Adjusted mean change in STICS-m score at year 6 for each tertile of the exploratory Western dietary pattern.
Fig. 2: Adjusted mean change in STICS-m score at year 6 for each tertile of the exploratory Mediterranean dietary pattern.

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We thank other members of the SUN Group: Alonso A, Álvarez-Álvarez I, Balaguer A, Barbagallo M, Barrientos I, Barrio-López MT, Basterra-Gortari FJ, Battezzati A, Bazal P, Benito S, Bertoli S, Bes-Rastrollo M, Beulen Y, Beunza JJ, Buil-Cosiales P, Canales M, Carlos S, Carmona L, Cervantes S, Cristobo C, de Irala J, de la Fuente-Arrillaga C, de la O V, de la Rosa PA, Delgado-Rodríguez M, Díaz-Gutiérrez J, Díez Espino J, Donat-Vargas C, Donazar M, Eguaras S, Fernández-Montero A, Fresán U, Galbete C, García-Arellano A, García López M, Gardeazábal I, Gea A, Gutiérrez-Bedmar M, Gomes-Domingos AL, Gómez-Donoso C, Gómez-Gracia E, Goñi E, Goñi L, Guillén F, Henríquez P, Hernández A, Hershey MS, Hidalgo-Santamaría M, Hu E, Lahortiga F, Leone A, Llorca J, López del Burgo C, Marí A, Marques I, Martí A, Martín Calvo N, Martín-Moreno JM, Martínez JA, Lapiscina EH, Mendonça R, Menéndez C, Molendijk M, Molero P, Murphy K, Núñez-Córdoba JM, Pajares R, Papadaki A, Parletta N, Pérez de Ciriza P, Pérez Cornago A, Pérez de Rojas J, Pimenta AM, Pons J, Ramallal R, Rico-Campà A, Romanos A, Ruano C, Ruiz L, Ruiz-Canela M, Ruiz Zambrana A, Salgado E, San Julián B, Sánchez D, Sánchez-Bayona R, Sánchez-Tainta A, Sánchez-Villegas A, Santiago S, Sayón-Orea C, Schlatter J, Serrano-Martinez M, J, Tortosa A, Valencia F, Vázquez Z, Zarnowiecki D, and Zazpe I. We thank very specially all participants in the SUN cohort for their long-standing and enthusiastic collaboration and our advisors from Harvard TH Chan School of Public Health Walter Willett, Alberto Ascherio, Frank B. Hu, and Meir J. Stampfer who helped us to design the SUN Project.


The SUN Project has received funding from the Spanish Government-Instituto de Salud Carlos III, and the European Regional Development Fund (FEDER) (RD 06/0045, CIBER-OBN, Grants PI10/02658, PI10/02293, PI13/00615, PI14/01668, PI14/01798, PI14/01764, PI17/01795, and G03/140), the Navarra Regional Government (27/2011, 45/2011, 122/2014), and the University of Navarra.

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MAM-G and ET designed research, MIM-G did the literature search and wrote the first draft. MIM-G, ET, and CR were responsible for data analysis. MAM-G, CR, and ET were responsible of conducting research. MAM-G, ET, and CR had primary responsibility for final content. MF-M and FG-G, together with the other authors, contributed to data interpretation and critical review of the manuscript.

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Correspondence to E. Toledo.

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The authors declare no competing interests.

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To obtain informed consent, we suitably informed the candidates of their right to refuse to participate in the SUN study or to withdraw their consent at any time without reprisal, according to the Declaration of Helsinki. Their voluntary completion of the baseline questionnaire was understood as freely given informed consent. Participants in the cognitive function subproject provided a specific written informed consent. These methods were accepted by the Institutional Review Board of the University of Navarra.

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Muñoz-García, M.I., Martínez-González, M.A., Razquin, C. et al. Exploratory dietary patterns and cognitive function in the “Seguimiento Universidad de Navarra” (SUN) Prospective Cohort. Eur J Clin Nutr 76, 48–55 (2022).

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